Do you remember how ridiculous it seemed when so-called experts tried to diagnose Osama bin Laden with kidney failure via videotape, or tried to will Terri Schiavo back to consciousness without ever examining her?
The current furor over the health status of Bowe Bergdahl makes those awkward media moments seem trivial by comparison.
“We had a prisoner of war whose health had deteriorated and we were deeply concerned about — and we saw an opportunity and we seized it,” President Obama said this week at a press conference.
Sounds like what physicians would say as a justification for transferring a patient from one hospital to another to save his life. Only in that case the decision would be made based on an in-person examination, lab tests, X-rays, EKGs, and vital signs. In this case, the determination came without any doctor’s direct involvement and without any specific medical information whatsoever. The closest to a medical analysis came from Senator Dick Durbin, another non-physician, who said after viewing the proof-of-life-video shown before Congress this week: “He looked either drugged or sick or tired. But he did not look like a well person.”
Maybe Senator Durbin and President Obama have been reading too much about telemedicine lately, but the fact is that medical technology has not reached the point where a propaganda video can be analyzed by anyone, even a seasoned physician with incredible intuition and diagnostic abilities, for diagnosis (Durbin) or prognosis (Obama).
Don’t get me wrong, I am not saying that I can tell nothing from a remote video. If the patient was gaunt, I might consider that he was suffering from starvation; if he was yellow as a lemon, I might think of liver failure; if he was unresponsive entirely, I might suggest coma from severe infection or head trauma; and if he was sweating profusely and looked like a ghost, I might think of infection or anemia.
The fact that none of these realities apply to any of Bergdahl’s videos is almost beside the point. Where were the physicians making the assessments that led to the wild speculations? I don’t believe that the president needed to put himself out on a medical limb to assess the sergeant’s health without proper information any more than I believe that he could have tried to guess whether Bergdahl had suicidal or homicidal tendencies.
It is a popular myth that you can just look at a person and tell how healthy he is, but the medical reality is far different. Before I can tell you how sick you are, I need to examine you and look over your records, and even then I may not know.
It is impossible to believe that the Taliban would have handed over Bergdahl’s blood pressure or white-blood count or chest X-ray to the enemy, much less taken these tests in the first place. This story keeps building based on an initial fallacy: that it is somehow possible to assess a person’s health status via video. From there the debate among non-doctors has grown — some arguing that at the time of the transfer he was blinking from lack of sunlight, others saying it was something that had gotten in his eyes, still others claiming it was feigned. Some say he was drugged, others that he was malnourished, and still others that the progression of videos shows a prisoner in much better shape than the administration claims.
But the bottom line is that no medical professionals are weighing in, and no American physicians (probably no physicians at all) examined Bergdahl or tested him in any way while he was in Afghanistan.
To determine whether the Bergdahl deal was worth it or was time-sensitive, Team Obama had to work with only the limited information it had, of course. But it seems to have had no useful medical information about Bergdahl. So the determination to strike a deal for his release in part because of deteriorating health is either entirely a fabrication or else based entirely on self-delusion. Or maybe the commander-in-chief who promised America’s patients that they would get to keep their doctors now thinks he is one.
If so, as a senior physician with far more clinical experience than he, I would offer as my best advice to our doctor/president that you can’t make a diagnosis or determine someone’s health status without ever seeing him, and if a doctor acts without that information, he or she could get sued for malpractice, at the very least.
— Marc Siegel, M.D., is a professor of medicine at the NYU Langone Medical Center and medical director of the center’s Doctor Radio. He is a member of the Fox News Medical A Team and the author of The Inner Pulse: Unlocking the Secret Code of Sickness and Health.